<p>Perhaps in no other health programme is bridging the gap between ‘haves’ and ‘havenots’ as important as it is in the immunisation programme. Vaccines save lives and to save maximum number of lives from preventable diseases, each child has to be reached and vaccinated. However, reaching every child repeatedly and giving an effective vaccine at specific age according to the immunisation schedule is a challenge. <br /><br /></p>.<p>India operates the world’s largest immunisation programme. Every year, the country targets newborns equivalent to the entire population of Australia (about 27 million) to administer vaccines against 9 preventable diseases, along with 30 million pregnant women. Despite these impressive figures, India is home to one-third of the world’s unimmunised or partially immunised children (6.8 million). <br /><br />Every third child in India is not fully immunised. Every year, 5 lakh children die due to preventable diseases. And another 89 lakh remain at risk, because they are unimmunised or partially immunised against those diseases. The current rate of fully immunised children is about 65%. <br /><br />India has a target of achieving 90% immunisation coverage by 2020. This will be difficult to reach unless gaps in the process are closed. In a bid to draw attention to these gaps, the theme for the World Immunisation Week 24-30 April 2016 is termed “Close the immunisation gap. Immunisation for all throughout life.”<br /><br />The traditionally acknowledged underlying gaps in immunisation are – inadequate supply of vaccines, lack of access to health services, a shortage of accurate information and insufficient political and financial support. <br /><br />Various surveys are conducted provide key health information including immunisation coverage data. For example, the National Family Health Survey (NFHS), district-level household surveys, the annual health surveys, and immunisation coverage evaluation surveys, especially those conducted by the United Nations Children’s Emergency Fund (Unicef).<br /><br />Successive surveys have indicated that there is a sustained improvement in the number of children immunised and the percentage of fully immunised children. But the rate of progress is slow. It has grown by approximately 1% every year since 2009. By 2014, immunisation coverage increased to just 65%. <br /><br />There is also an equity gap in routine immunisation services provided. A systematic review, published by the Post Graduate Institute of Medical Education and Research, Chandigarh, of the 3 NFHS, a research study of the Indian Council of Medical Research, UNICEF coverage evaluations, and several publications representing different population groups or geographic regions, indicate that there is a considerable equity gap in vaccination coverage in different states and within states. <br /><br />Generally poor performing states have greater inequities. The gap was highest in Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand and Uttar Pradesh.<br /><br />The NFHS-3 survey reported 57.6% of urban infants were fully immunised compared to 38.6% rural. The survey also reported that infants of general category families had higher vaccination coverage rates than those of SC/ST and other backward classes. <br /><br />Boosting immunity<br /><br />To close this gap, the Ministry of Health & Family Welfare launched a Mission Indradhanush (MI) in 2014 to vaccinate all unreached children. The MI strategy helps to address the equity gaps in immunisation coverage and give a rapid boost to immunisation coverage which will then be sustained by routine services. <br /><br />It aims to provide immunisation services to children residing in areas where no auxiliary nurse midwifery (ANM) is posted for more than 3 months, those where ANMs are on long leave, high risk areas such as urban slums, forest areas, pockets with disease outbreaks, hamlets, which have not had independent routine immunisation sessions.<br /><br />The first phase was launched in April-July 2015 and the second phase from October 2015 -January 2016. These have produced encouraging results with more than 148 lakh children being vaccinated, 38 lakh children being fully vaccinated along with 38 lakh pregnant women. The third phase of the MI was launched in April and 2 rounds have been completed till May.<br /><br />Having achieved and maintained a zero-polio status (2014) and more recently, eliminated maternal and neonatal tetanus (2015), the momentum has increased and it gives hope and confidence that the country will be able to plug the gaps and achieve the target of 90% fully immunised children by 2020. <br /><br /><em>(The writer is Senior Adviser, Infectious Diseases, Public Health Foundation of India, New Delhi)</em></p>
<p>Perhaps in no other health programme is bridging the gap between ‘haves’ and ‘havenots’ as important as it is in the immunisation programme. Vaccines save lives and to save maximum number of lives from preventable diseases, each child has to be reached and vaccinated. However, reaching every child repeatedly and giving an effective vaccine at specific age according to the immunisation schedule is a challenge. <br /><br /></p>.<p>India operates the world’s largest immunisation programme. Every year, the country targets newborns equivalent to the entire population of Australia (about 27 million) to administer vaccines against 9 preventable diseases, along with 30 million pregnant women. Despite these impressive figures, India is home to one-third of the world’s unimmunised or partially immunised children (6.8 million). <br /><br />Every third child in India is not fully immunised. Every year, 5 lakh children die due to preventable diseases. And another 89 lakh remain at risk, because they are unimmunised or partially immunised against those diseases. The current rate of fully immunised children is about 65%. <br /><br />India has a target of achieving 90% immunisation coverage by 2020. This will be difficult to reach unless gaps in the process are closed. In a bid to draw attention to these gaps, the theme for the World Immunisation Week 24-30 April 2016 is termed “Close the immunisation gap. Immunisation for all throughout life.”<br /><br />The traditionally acknowledged underlying gaps in immunisation are – inadequate supply of vaccines, lack of access to health services, a shortage of accurate information and insufficient political and financial support. <br /><br />Various surveys are conducted provide key health information including immunisation coverage data. For example, the National Family Health Survey (NFHS), district-level household surveys, the annual health surveys, and immunisation coverage evaluation surveys, especially those conducted by the United Nations Children’s Emergency Fund (Unicef).<br /><br />Successive surveys have indicated that there is a sustained improvement in the number of children immunised and the percentage of fully immunised children. But the rate of progress is slow. It has grown by approximately 1% every year since 2009. By 2014, immunisation coverage increased to just 65%. <br /><br />There is also an equity gap in routine immunisation services provided. A systematic review, published by the Post Graduate Institute of Medical Education and Research, Chandigarh, of the 3 NFHS, a research study of the Indian Council of Medical Research, UNICEF coverage evaluations, and several publications representing different population groups or geographic regions, indicate that there is a considerable equity gap in vaccination coverage in different states and within states. <br /><br />Generally poor performing states have greater inequities. The gap was highest in Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand and Uttar Pradesh.<br /><br />The NFHS-3 survey reported 57.6% of urban infants were fully immunised compared to 38.6% rural. The survey also reported that infants of general category families had higher vaccination coverage rates than those of SC/ST and other backward classes. <br /><br />Boosting immunity<br /><br />To close this gap, the Ministry of Health & Family Welfare launched a Mission Indradhanush (MI) in 2014 to vaccinate all unreached children. The MI strategy helps to address the equity gaps in immunisation coverage and give a rapid boost to immunisation coverage which will then be sustained by routine services. <br /><br />It aims to provide immunisation services to children residing in areas where no auxiliary nurse midwifery (ANM) is posted for more than 3 months, those where ANMs are on long leave, high risk areas such as urban slums, forest areas, pockets with disease outbreaks, hamlets, which have not had independent routine immunisation sessions.<br /><br />The first phase was launched in April-July 2015 and the second phase from October 2015 -January 2016. These have produced encouraging results with more than 148 lakh children being vaccinated, 38 lakh children being fully vaccinated along with 38 lakh pregnant women. The third phase of the MI was launched in April and 2 rounds have been completed till May.<br /><br />Having achieved and maintained a zero-polio status (2014) and more recently, eliminated maternal and neonatal tetanus (2015), the momentum has increased and it gives hope and confidence that the country will be able to plug the gaps and achieve the target of 90% fully immunised children by 2020. <br /><br /><em>(The writer is Senior Adviser, Infectious Diseases, Public Health Foundation of India, New Delhi)</em></p>
